Peanut WA
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(9/25/00 12:47 am)
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Antipsychotics & Stimulants for ADHD/CD - Medscape
CHICAGO The addition of novel antipsychotics to psycho-stimulants eases attention and behavior problems in children with concurrent attention-deficit hyperactivity disorder and conduct disorder, Dr. Mohammed Z. Hussain said at the annual meeting of the American Psychiatric Association.
Risperidone and olanzapine seem to be well tolerated and may in fact improve side effects associated with psychostimulant therapy, said Dr. Hussain of Prince Albert, Sask.
Conduct disorder is common among children and adolescents with attention-deficit hyperactivity disorder (ADHD): Its prevalence is 30%-50%, according to various studies.
Psychostimulant therapy, the treatment of choice for ADHD, has limitations with this group. Although a broad range of effects in the areas of concentration and attention are well maintained over the long term, effects on aggression and opposition are not. In many patients, side effects such as insomnia or headache require dose reduction.
Dr. Hussain reported results of a 52-week open-label trial with 50 children and adolescents with concurrent ADHD and conduct disorder who had responded partially to treatment with methylphenidate or dextroamphetamine.
They were randomized to receive risperidone (0.25-1 mg) or olanzapine (1.25-5 mg) in addition to the stimulant regimen.
Eleven patients dropped out of the study early - within 2 weeks - because of parental perceptions of ineffectiveness or adverse effects or discomfort with the idea of their children taking an antipsychotic medication.
Among the 39 patients remaining in the study, 20 received olanzapine and 19 received risperidone.
The children in both groups improved markedly in conduct problems, impulsive hyperactivity, and psychosomatic symptoms as assessed by the Conners' Parent Rating Scale.
Improvement in anxiety also was seen among the small number of children who had high baseline scores on this scale. Learning problems improved "to a degree," Dr. Hussain said.
Scores on the Conners Teachers Rating Scale showed a substantial drop in hyperactivity, emotionality, and daydreaming, he said.
The antipsychotics were well tolerated; in particular, the weight gain that has been a problem in other populations did not occur here.
The drugs also redressed some adverse effects associated with stimulant therapy: Sleep improved, emotionality was reduced, and appetite increased, he said. Olanzapine and risperidone were similarly effective in all respects except in learning in which risperidone effected a slightly greater improvement.
"This could reflect the fact that olanzapine is more anticholinergic than risperidone," Dr. Hussain said.
Improvement in behavior generally became noticeable to participants within the first 3 months of the study.
Upon the whole, "teachers, parents, and children were very happy" with the treatment, he said.
Dr. Hussain did not disclose any financial links with either of the drug manufacturers.
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